Healthcare Provider Details

I. General information

NPI: 1316029770
Provider Name (Legal Business Name): EAST TEXAS MEDICAL CENTER HOME SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 COUNTY ROAD 4114 SUITE 2
PITTSBURG TX
75686-4199
US

IV. Provider business mailing address

19 COUNTY ROAD 4114 SUITE 2
PITTSBURG TX
75686-4199
US

V. Phone/Fax

Practice location:
  • Phone: 903-856-6554
  • Fax: 903-856-0084
Mailing address:
  • Phone: 903-856-6554
  • Fax: 903-856-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number010659
License Number StateTX

VIII. Authorized Official

Name: MR. CURT L SMITH
Title or Position: CORP. DIRECTOR/ADMINISTRATOR
Credential:
Phone: 903-535-6056